Should I use an anti-resorptive agent after Forteo?

Hi sallyj2, could you give a link re using hrt as a background vs using hrt for off period for the cyclic method, when you get a chance? I’m very interested in reading how the end results would differ. Thanks a lot!

Hello @06111945cc

I have one datapoint for you on the proposed intermittent Forteo (Teriparatide). Below is a slide from a Dr. Michael McClung presentation at the 2023 World Congress of Osteoporosis that shows a study of Forteo used on and off for 4 years without treatment between breaks. The study is listed at the bottom of the slide. It might make sense to use a bisphosphonate like alendronate in-between breaks, but I have no data here. If you do, perhaps you can share.

Mike

I’m very interested in the intermittent use in forteo and alendronate to avoid rebound bone loss after forteo treatment. I would also like to know how bone markers can be used. If someone has good articles they recommend I would be very interested to take them to my provider. Not sure about sharing specific provider recommendations on this sharing platform, but if anyone knows of a specialist/group in Minnesota that uses this approach I’d be interested in that too.

@felicitypevancy - Dr. McCormick outlines how to use bone markers. Check it out. He uses CTX (indicator of bone breakdown) and P1NP (indicator of bone building) before treatment. Then after 3 months on meds repeats P1NP to see if it’s working. There are specific things to do and the timing of when you are tested that are important to help values be valid and comparable. Don't take my word for it - get his book , GREAT BONES, and read for yourself. Or listen to a podcast he did with Margie Bissinger , I believe in January where he discussed this. Good luck!!

Does anyone know if the transition from Forteo to generic Teriparatide causes any symptoms. I need to switch to Teriparatide for my final three months(of a two year time frame) to the generic because it has gone up to $3,000.
a month.

@janflute it might be best if you could find study data comparing the generic vs forteo. Anecdotal accounts may offer comfort to your mind, but may not be reproducible due to individual variation.

Formulation like tablets have binders, fillers and outside coatings. When a generic is made, while the active ingredients would and should be the same, the remaining inactive ingredients may not. This might cause variations in tablets’ disintegrating rate and in turn affecting rate or extend of absorption and max blood concentration etc. This is why there are people insisting to have a particular generic brand of a, say blood pressure med (because the effects are very noticeable) instead of another, although they are the same or have the same active ingredient.

Biologics like teriparatide/forteo are made from recombinant technology, there is no need to doubt their active ingredient. The differences might be in carrier media, delivery pen, as well as the usage of preservatives, if any. There sure were clinical trials before a generic is approved by FDA. If trial data were not available, you can check the generic rating. If it’s ab rated (rating always includes efficacy), personally I wouldn’t worry too much.

@felicitypevancy - Dr. McCormick outlines how to use bone markers. Check it out. He uses CTX (indicator of bone breakdown) and P1NP (indicator of bone building) before treatment. Then after 3 months on meds repeats P1NP to see if it’s working. There are specific things to do and the timing of when you are tested that are important to help values be valid and comparable. Don't take my word for it - get his book , GREAT BONES, and read for yourself. Or listen to a podcast he did with Margie Bissinger , I believe in January where he discussed this. Good luck!!

I thought CTX checked for bone building

P1np is bone break down